British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Drug patient information leaflets in anaesthesia: effect on anxiety and patient satisfaction.
Patient information leaflets are produced for all new drugs, including anaesthetic drugs that are licensed solely for physician administration. The effect of this information on patients' satisfaction and anxiety has not been investigated previously. ⋯ A minority of patients (up to 36%) wish to receive detailed anaesthetic drug information before anaesthesia. Manufacturers' drug patient information leaflets do not alter preoperative anxiety and may be safely issued to patients requesting such information.
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The Narcotrend (Monitor Technik, Bad Bramstedt, Germany) assesses sedation by automatic classification of EEG signals, using a scale first used for visual evaluation of the EEG. Limited information is available on its value, and only a few studies of the method exist. We set out to study the performance of the Narcotrend during propofol sedation. ⋯ The Narcotrend can monitor sedation with propofol. Other sedatives, anaesthetics and opioids should be used to test this monitor.
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Mid-line thoracotomy is a standard approach for cardiac surgery. However, little is known how this surgical approach affects the interaction between the circulation and mechanical ventilation. We studied how mid-line thoracotomy affects cardiac filling volumes and cardiovascular haemodynamics, particularly variations in stroke volume and pulse pressure caused by mechanical ventilation. ⋯ Thoracotomy increases cardiac filling and preload. Further, thoracotomy reduces the effect of mechanical ventilation on left ventricular stroke volume. However, also under open chest conditions, SVV and PPV are preload-dependent.
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Case Reports
Spinal epidural abscess--a rare complication after epidural analgesia for labour and delivery.
We report a case of spinal epidural abscess formation after short-term epidural catheter placement for analgesia during labour and delivery. The patient was previously healthy and did not have any predisposing factors. Increasing back pain was the only complaint. ⋯ Magnetic resonance imaging was performed and showed a large triangular-shaped abscess with adjacent inflammation of the paravertebral muscles. One day later, the patient developed a sensory deficit in the left lower limb. The neurological deficit completely resolved after surgical decompression and debridement, which was followed by antibiotic treatment.
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Carcinoid syndrome creates many challenges during anaesthesia, including hypertension, hypotension and bronchospasm. These challenges are less common and less severe after the routine use of octreotide. ⋯ The combination of perioperative octreotide administration, intraoperative remifentanil infusion and sevoflurane anaesthesia, with postoperative epidural analgesia proved satisfactory. We review the recent literature and suggest that remifentanil is a useful addition to the armamentarium of the anaesthetist in the management of a patient with carcinoid syndrome.